Umbilical Enterocutaneous Fistula

hernial sac or subcutaneous tissue would consistently demonstrate signs of colic, this does not occur in most cases of strangulating umbilical hernias. Horses with intestinal incarceration within an umbilical hernia can have several different clinical presentations. The most common is a reducible umbilical hernia in a young horse (i.e., usually 6 to 12 months of age) that develops acute abdominal pain concurrent with a firm, painful, nonreducible umbilical hernia. The antimesenteric surface of the ileum is most commonly incarcerated, which is called a parietal or Richter’s hernia (Figure 1). On rare occasions, the small intestine may rupture through the hernial sac and dissect subcutaneously. Depending on the duration of the incarceration and the amount of bowel involved, the bowel may not need to be resected. In some cases, wedge resection of damaged bowel can be performed instead of complete resection and anastomosis. However, the bowel does not always remain incarcerated permanently; therefore, signs of abdominal pain and significant umbilical swelling may be intermittent and unnoticed, as illustrated in this report. I have also examined a few horses with incarcerated umbilical hernias that corrected while the patients were being transported to the hospital for surgery. Because the duration of the incarceration is usually undetermined in such cases, exploratory celiotomy should be performed to evaluate the health of the previously entrapped bowel. A third clinical scenario is for the horse to present with swelling in the umbilical area without a history of colic, drainage, or other problems. Even without a history of colic, the bowel (usually ileum, large colon, or cecum) can be permanently incarcerated within the hernia. Alternatively, the bowel may have been entrapped for a prolonged period (resulting in inflammation and swelling around the umbilicus) and then spontaneously returned to the abdomen. Whether the bowel is incarcerated can usually be determined by a combination of external palpation and ultrasonography of the umbilical Umbilical Enterocutaneous Fistula CASE NOTES AND COMMENTARY